Our DrillCover surgical tools are used by orthopedic surgeons around the world. We recently spoke with an orthopedic surgeon at one of the major government hospitals in East Africa that serve as a tertiary referral and teaching hospital, treating over 30,000 in-patients and 250,000 out-patients annually. 

 

Serving the under-served

Low and middle-income countries have a growing need for trauma and orthopedic surgical interventions, but many lack surgical resources. The need stems from an upsurge in road accidents and poor institutional health infrastructure.

Orthopedic surgeons at these hospitals across East Africa see large numbers of people suffering and dying all through their medical careers. Surgeons put in long hours to serve the community, and often sacrifice their own health and time with their families to make a difference serving under-served people. 

Too few orthopedic surgeons

At most of these hospitals, there are very few orthopedic and trauma surgeons, significantly below the World Health Organization (WHO) recommended numbers. As a result, a  surgeon is likely to work at two or three facilities hundreds of kilometers apart, with little support for moving between medical facilities. 

Source: https://www.researchgate.net/figure/A-graphical-representation-of-surgeon-density-per-100-000-people-by-country-income-group_fig2_309655398

Non-existent pre-hospital care

At the referral hospital in East Africa, pre-hospital trauma care, such as an ambulatory pick-up service, is virtually nonexistent. Most patients are brought to the hospital by well-wishers, family members, or the police. This also means that the severely injured rarely even make it to the hospital. 

Transportation is very expensive for rural communities, meaning people often don’t seek medical help until it is clear that they are not recovering on their own or with the help of a traditional healer. Typically patients will be referred to the nearest district hospital, which has fewer treatment options. For orthopedic cases, this usually means the only choices are plaster casting or traction. If the patient is referred to the tertiary referral hospital, valuable time has been lost and the patient is often at greater risk of permanent damage or infection. 

Lack of orthopedic equipment

While insufficient personnel and logistics contribute to the challenging condition of orthopedic surgery in low- and middle-income countries, the lack of orthopedic products is still the biggest factor. The situation is so dire that it comes at the cost of patient well-being and outcomes. A patient may be forced to spend months on a traction device, where internal fixation would have enabled the patient to be discharged in mere hours.

If these hospitals had access to sterile, orthopedic surgical tools, treatment could be very different. Overwhelming and well-documented evidence shows that IM nailing has better patient results and is more cost-effective than traction, but due to lack of surgical tools, femoral fractures are still primarily treated with traction. Traction confines patients to the bed for up to three months and leaves them dependent on walking aids for another six to 12 weeks. 

What is needed?

Orthopedic equipment that is essential and desirable for low resource settings includes:

  • Traction and plaster casts for district hospitals or non-operative care providers
  • For secondary hospitals providing trauma and basic orthopedic procedures, orthopedic surgical tools such as the DrillCover Hex or DrillCover Pro, or the SawCover oscillating saw, as well as small fragment sets, large fragment sets, SIGN/rush nailing, external fixators, K wiring sets and large cannulated screws For tertiary hospitals providing trauma and advanced orthopedic care, including total hip and knee replacements, orthopedic power tools like the DrillCover system, total hip and knee replacement sets, and reduction clamps for pelvic operations.

Impact of orthopedic surgery on a local patient

About six million people die annually from trauma injuries, more than from HIV/AIDS, tuberculosis, and malaria combined. More than 90% of these fatal injuries occur in low- and middle-income countries. For every death from injury, between three to 10 more people survive an injury with a permanent disability, causing a serious impact on the family of the injured. Coupled with the lack of social security systems, the injury of a breadwinner can be detrimental to the economic situation of the entire family and can push them further into poverty. 

 

That’s why Arbutus Medical has the mission of providing safe surgery for all, making orthopedic care accessible for all, and alleviating the greater burden of injury.

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